BACKGROUND: We reviewed retrospectively the clinical features and contrast material-enhanced computed tomography(CT) after blunt abdominal trauma demonstrated a characteristic hypoperfusion complex. Our purpose were to evaluate the hypothesis that children with this 'hypoperfusion complex' CT finding were associated with a tenuous hemodynamic state, severe injury and a poor outcome. METHODS: Between January 1996 and December 1999, 39 consecutive children who sustained blunt trauma and were suspected clinically of having intraabdominal injury underwent CT. Demographic data, blood pressure, indication for CT, pediatric trauma score(PTS) and Glasgow coma score(GCS) were recorded at the time of the initial examination. RESULTS: Three of the 39 children(8%) demonstrated a characteristic finding at CT which was described as the hypoperfusion complex. The 'hypoperfusion complex' was present in the 3 of the 39 traumatized children(8%), but was the main radiographic finding in the 3 of the 14 children with a severe pediatric trauma score(PTS<8) and in the 3 of the 6 children with a Glasgow coma score(GCS<8) who were examined with CT. CONCLUSION: The CT finding in all children with the hypoperfusion complex by definition included marked, diffuse dilatation of the intestine with fluid; abnormally intense contrast enhancement of the bowel wall, mesentery, kidney and/or pancreas; decreased caliber of the abdominal aorta and inferior vena cava(IVC); and moderate to large peritoneal fluid collection. This 'hypoperfusion complex' is a relatively rarely observed in injured children but appears to be associated with severe injury and a poor outcome. The pediatric trauma score provides a useful profile of injury severity in children. Prompt diagnosis of hypovolemic shock is important so that supportive therapy can be instituted to prevent further metabolic abnormalities and their potential cardiotoxic effects. In summary, the intense multiorgan enhancement pattern seen in the hypoperfusion complex indicates tenuous hemodynamic stability and is associated with a poor outcome.
Aorta, Abdominal ; Ascitic Fluid ; Blood Pressure ; Child* ; Coma ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Hypovolemia* ; Intestines ; Kidney ; Mesentery ; Pancreas ; Retrospective Studies ; Shock* ; Tomography, X-Ray Computed*

Fracture of the femoral neck occurred after internal fixation of intertrochanteric fracture of the femur is very rare and have been described previously in terms of stress fracture, stress-riser fracture, Youngs modulus fracture or iatrogenic fracture in the literature. This fracture documented about 20 cases in the English literature and usually occurred in elderly patients with osteoporosis and it always occur in the subcapital region. We report a case of subcapital stress fracture of the femur occurred after internal fixation with compression hip screw of intertrochanteric femur fracture.
Aged ; Elastic Modulus ; Femur Neck ; Femur* ; Fractures, Stress* ; Hip ; Humans ; Osteoporosis

Open carpal tunnel release surgery has heen the gold standard method of treatment for who did not respond to conservative treatment and whose neurologic symptoms were progressive. However, open carpal tunnel release using a standard incision frequently associated with delayed return of hand function, residual scar tenderness and pillar pain. So, two new alternative methods such as endoscopic carpal tunnel release and limited incision technique have developed. To define the role of the limited two incision technique, we anaiyzed the postoperative functional results of 40 cases in 33 patients. The patients were divided in two groups. Group A was standard incision group (23 cases in 19 patients) and Group B was limited two incision group (l7 cases in 14 patients). The postoperative functional results were analyzed statistically using chi-square test at postoperative 3, 6, 9 and l2 weeks. There were no significant differences in reliet of numbness and paresthesias in both groups. There was a statistically significant difference in relief of scar tenderness and pillar pain at postoperative 3 and 6 weeks in Group B. There was no significant complication in both groups. We can conclude that the limited two incision technique of carpal tunnel release is a safe procedure which allows rapid return of hand functions with reduced incidence of scar tenderness in the early postoperative stages.
Carpal Tunnel Syndrome ; Cicatrix ; Hand ; Humans ; Hypesthesia ; Incidence ; Neurologic Manifestations ; Paresthesia

Ossifications of the ligamentum flavum(OLF) and the posterior longitudinal ligament(OPLL) are uncommon clinical entities as a cause of the progressive compression myelopathy or radiculopathy. Although there are considerable literatures concerning OPLL or OLF in cervical and thoracic spine, there are only a few references about OPLL or OLF in the lumbar spine. OLF and OPLL have been reported that they may lead to severe complication only with a minor trauma or even without trauma, such as paraplegia. The authors have experienced 2 cases of OLF accompanied by OPLL In the lumbar spine, who were treated with decompressive laminectomy and excision of ossified ligaments. For its rarity of OLF and OPLL in the lumbar region, we report here with review of literature.
Laminectomy ; Ligaments ; Ligamentum Flavum* ; Longitudinal Ligaments* ; Lumbosacral Region ; Paraplegia ; Radiculopathy ; Spinal Cord Diseases ; Spine*

A group of pseudophakic patients (21eyes) without complications, such as zonular dam age, posterior synechia and posterior capsular tear, was investigated to determine whether their implants (pharmacia, cilco, AMO) shift under the ciliary muscle stimulation. A change in anterior chamber depth between with accommodation and without accommodation was found. By presenting as accommodation stimulus to the normal fellow eye, the intraocular lens in the pseudophakic eye moved slightly in a forward direction. But, it is not enough to explain apparent accommodation in pseudophakic eyes.
Anterior Chamber* ; Humans ; Lenses, Intraocular

BACKGROUND: Liquid chromatographyetandem mass spectrometry (LC-MSMS) for simultaneous analysis of multiple microbial secondary metabolites (MSMs) is potentially subject to interference by matrix components. METHODS: We examined potential matrix effects (MEs) in analyses of 31 MSMs using ultraperformance LC-MSMS. Twenty-one dust aliquots from three buildings (seven aliquots/building) were spiked with seven concentrations of each of the MSMs (6.2 pg/µl–900 pg/µl) and then extracted. Another set of 21 aliquots were first extracted and then, the extract was spiked with the same concentrations. We added deepoxy-deoxynivalenol (DOM) to all aliquots as a universal internal standard. Ten microliters of the extract was injected into the ultraperformance LC-MSMS. ME was calculated by subtracting the percentage of the response of analyte in spiked extract to that in neat standard from 100. Spiked extract results were used to create a matrix-matched calibration (MMC) curve for estimating MSM concentration in dust spiked before extraction. RESULTS: Analysis of variance was used to examine effects of compound (MSM), building and concentration on response. MEs (range: 63.4%–99.97%) significantly differed by MSM (p < 0.01) and building (p < 0.05). Mean percent recoveries adjusted with DOM and the MMC method were 246.3% (SD = 226.0) and 86.3% (SD = 70.7), respectively. CONCLUSION: We found that dust MEs resulted in substantial underestimation in quantifying MSMs and that DOM was not an optimal universal internal standard for the adjustment but that the MMC method resulted in more accurate and precise recovery compared with DOM. More research on adjustment methods for dust MEs in the simultaneous analyses of multiple MSMs using LC-MSMS is warranted.
2,5-Dimethoxy-4-Methylamphetamine ; Calibration ; Dust ; Mass Spectrometry ; Methods

Pulmonary arterial hypertension (PAH) secondary to chronic obstructive pulmonary disease (COPD) is incurable and it has an unpredictable survival rate. Two men who suffered from COPD presented with progressive dyspnea and edema, respectively. PAH, as estimated by the peak velocity of tricuspidal regurgitation, and the depressed myocardial performance index (MPI) of the right ventricle (RV) were noted on echocardiography. In addition to the baseline therapy for their depressed ventilatory function, we prescribed tadalafil 10 mg orally every other day for 2 weeks and then we doubled the dosage. They well tolerated the medication without any notable side effects. After 4 weeks of tadalafil treatment, the patients' pulmonary arterial pressure was decreased and the MPI of the RV was improved in both. The exercise capacity, as measured by the respiratory oxygen uptake, also improved from 10.9 mL/kg/min to 13.8 mL/kg/min in one patient. We report here on 2 patients with PAH secondary to COPD, and they showed notable improvement of their pulmonary hemodynamics and exercise capacity with the administration of tadalafil.
Pulmonary Disease, Chronic Obstructive/*complications ; Pulmonary Artery/drug effects/*pathology ; Phosphodiesterase Inhibitors/*therapeutic use ; Oxygen Consumption/drug effects ; Middle Aged ; Male ; Hypertension, Pulmonary/*drug therapy/etiology ; Humans ; Exercise Tolerance/drug effects ; Carbolines/*therapeutic use

This study reports a case of anaplastic transformation from a well-differentiated thyroid carcinoma in a young patient. The first recurrent tissue contained poorly differentiated foci that revealed lower thyroglobulin, thyroid transcription factor 1 (TTF-1), and galectin-3 expression than the well-differentiated area. However there was no increased p53 or Ki-67 expression in the poorly differentiated foci, nor in the well-differentiated area. The tissue subsequently relapsed and revealed only anaplastic features, complete loss of thyroglobulin, TTF-1, and galectin-3 expression and revealed an increase in p53 and Ki-67 expression. The BRAF V600E and BRAF V600V mutation were found in the initially diagnosed papillary thyroid carcinoma and the poorly differentiated foci of the recurring papillary thyroid carcinoma; however, only the BRAF V600V mutation was found in the anaplastic carcinoma. These results suggest that overexpression of p53 and Ki-67 contributed to the anaplastic transformation. We also found that the BRAF type changed during the tumor relapse.
Carcinoma ; Galectin 3 ; Humans ; Immunohistochemistry ; Proto-Oncogene Proteins B-raf ; Recurrence ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms* ; Transcription Factors ; Young Adult

OBJECTIVES: This study measures serum prostate-specific antigen (PSA) levels in tire-manufacturing workers, and attempts to find occupational or non-occupational factors that related to their PSA levels. METHODS: A total of 1,958 healthy male workers (1,699 were production workers and 259 were office workers) took PSA measurement for analysis. RESULTS: After adjusting for age, body mass index, hypertension, regular exercise, alcohol drinking and smoking, which were significantly related to serum PSA levels or known related factors of serum PSA levels, the geometric mean PSA levels were significantly high in the office workers (p = 0.017), the older age group (p < 0.001), the group with hypertension (p = 0.046) and the group of individuals that do not exercise regularly (p = 0.015) and the office workers were more likely to have a serum PSA level of > or =4.0 (OR 7.73, 95% CI: 2.78-21.46) or 2.5 ng/mL (OR 2.74, 95% CI: 1.49-5.08). After stratifying by age and adjusting aforementioned covariates, office workers 50 years of age and older had the significantly higher geometric mean PSA levels (p = 0.017) and were more likely to have a serum PSA level of > or =4.0 ng/mL (OR 12.90, 95% CI: 3.65-45.64) or 2.5 ng/mL (OR 3.90, 95% CI: 1.64-9.25) than production workers 50 years of age and older. CONCLUSIONS: This study showed that serum PSA levels were significantly higher among the group with hypertension or the group of individuals that did not exercise regularly or group of office workers who were considered to have lesser physical activities.
Alcohol Drinking ; Body Mass Index ; Humans ; Hypertension ; Male ; Motor Activity ; Occupations ; Prostate-Specific Antigen* ; Sedentary Lifestyle ; Smoke ; Smoking

PURPOSE: To find the factors influencing the immediate and late outcome of replantation and revascularization of the digits, we carried out a prospective study from 1998 to 1999 with at least a 1-year followup. Traumatic total and subtotal amputations with inadequate circulation of the digits distal to the metacarpal head were included in the study. METHODS: This study was carried out as a prospective study from 1998 to 1999 with at least a 1- year followup. The relationship between age, sex, extent of injury, type of injury, ischemic time, regular smoking, level of injury, and survival rate were analyzed. There were 234 patients with 155 males (254 digits) and 79 females (129 digits). RESULTS: Successful operation was found in 203 patients (86.3%), 314 digits (82%). Although male patients seemed to have poorer survival rates than female, it should be noted that male patients had more severe injuries than female patients. All patients who were regular cigarette smokers were males. Cigarette smoking has been shown to cause cutaneous vasoconstriction, decrease the digital blood flow, and impair the wound healing. These two reasons might explain the lower survival rate in males than in females. Type of injury significantly affected the survival rate. The survival rate was very low in extensive crushed amputation (11.1% survival rate), followed by degloving (21.1% survival rate) and avulsion (64.7% survival rate) amputation. The level of injury also seemed to determine the survival rate as injury at Zone I (65% survival rate) resulted in a poor survival rate compared to the injury at Zone II, III, or IV (92%, 97.6%, or 90.9% survival rate). Ischemic time longer than 8 hours might lessen the survival rate. CONCLUSION: All patients who had successful replantation and revascularization were satisfied with the results even though they had rather poor hand movement. In single digital replantation, no patients needed reamputation, but all preferred to have their finger replanted than udergo a primary amputation. All could accommodate and adapt their injured digits to their work.
Amputation ; Female ; Fingers ; Follow-Up Studies ; Hand ; Head ; Humans ; Male ; Prospective Studies ; Replantation* ; Smoke ; Smoking ; Survival Rate ; Tobacco Products ; Vasoconstriction ; Wound Healing